Abstract
BackgroundProphylaxis for high-risk populations, such as forest workers, could be one component for malaria elimination in the Greater Mekong Sub-region. A study was conducted to assess the malaria incidence in forest rangers and the feasibility of malaria prophylaxis for rangers sleeping in forest camps.MethodsForest rangers deployed in the Bu Gia Map National Park, Vietnam were invited to participate in the study. Plasmodium infections were cleared using presumptive treatment, irrespective of malaria status, with a 3-day course dihydroartemisinin/piperaquine (DP) and a 14-day course of primaquine. Before returning to the forest, study participants were randomly allocated to a 3-day course of DP or placebo. Fifteen days after returning from their forest deployment the participants were tested for Plasmodium infections using uPCR.ResultsPrior to treatment, 30 of 150 study participants (20%) were found to be infected with Plasmodium. Seventeen days (median) after enrolment the rangers were randomized to DP or placebo 2 days before returning to forest camps where they stayed between 2 and 20 days (median 9.5 days). One ranger in the DP-prophylaxis arm and one in the placebo arm were found to be infected with Plasmodium falciparum 15 days (median) after returning from the forest. The evaluable P. falciparum isolates had molecular markers indicating resistance to artemisinins (K13-C580Y) and piperaquine (plasmepsin), but none had multiple copies of pfmdr1 associated with mefloquine resistance.ConclusionAnti-malarial prophylaxis in forest rangers is feasible. The findings of the study highlight the threat of multidrug-resistant malaria.Trial registration NCT02788864
Highlights
Prophylaxis for high-risk populations, such as forest workers, could be one component for malaria elimination in the Greater Mekong Sub-region
The purpose of the study was to: (1) measure the malaria incidence in forest rangers to determine the number of participants required in future studies to estimate the efficacy of anti-malarial prophylaxis in forest rangers; and, (2) assess the feasibility of malaria prophylaxis for rangers based in forest camps
The study was conducted between May and September 2016. 157 forest rangers were screened
Summary
Prophylaxis for high-risk populations, such as forest workers, could be one component for malaria elimination in the Greater Mekong Sub-region. The goal of malaria elimination has been endorsed by the Vietnamese Government, but this goal is jeopardized by the emergence and spread of Plasmodium falciparum resistance to artemisinins and partner drugs [2,3,4,5]. Accelerated elimination before the current arsenal of artemisinin combination therapy loses efficacy is probably the only way to stop the spread of anti-malarial resistance. The population attributable fraction of malaria cases acquired by forest-related activities has been estimated as high as 53% [12]. Vietnamese ethnic minorities carry a disproportionately large share of the malaria burden related to their remote settlements and the need to make a living through forest-related activities [10]
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